| NPI | 1073979100 |
|---|---|
| Former Name | MARY MOENICH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004508RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07987) |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2019-06-18 |